Consultant, EpiC Thailand (To review HIV service costing and pricing)

ORGANIZATIONAL OVERVIEW

Funded by the U.S. Agency for International Development (USAID) and managed by FHI 360, the Meeting Targets and Epidemic Control (EpiC) Project is a global project with specific scopes of work in multiple countries. In Thailand, EpiC focuses on interventions to reduce HIV transmission among men-who-have-sex-with-men (MSM), male sex workers (MSW), and transgender women (TGW) populations and to improve the quality of life of people living with HIV (PLHIV) in Thailand. Most interventions are implemented through community-based organizations (CBOs) in ten different parts of the country, namely Bangkok, Chonburi, Chiang Mai, Chiang Rai, Nonthaburi, Patumthani, Phitsanulok, Samutprakarn, Song Khla, and Ubonratchathani, and include reach-recruit-test-treat-prevent-retain (RRTTPR) interventions such as targeted online interventions on social media, differentiated service delivery for HIV testing, Pre-Exposure Prophylaxis, and antiretroviral treatment including telehealth services, and cross-cutting issues of stigma and discrimination reduction and policy advocacy.

Although the Thai Government supports an overwhelming majority of HIV response, most of the funding for interventions for key populations through local CBOs is currently supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) and the Global Fund for AIDS, TB, and Malaria. During the past 5 years, the National Health Security Organization (NHSO) has provided increased reimbursements to CBOs for their reach-to-rest interventions. However, there is recognition by all stakeholders that these reimbursements do not cover the full operational costs of the CBOs, nor do they incentivize HIV case finding. NHSO also does not reimburse CBOs for case management of HIV+ individuals who need to be initiated on ART nor high-risk HIV- individuals who may need to be initiated on pre-exposure prophylaxis (PrEP). These gaps thus necessitate the need for additional analyses and pricing recommendations to NHSO so that it can increasingly invest in effective HIV services at the community level.

REQUIRED SERVICES

EpiC Thailand managed by FHI 360 is seeking the support of an individual consultant to review and examine existing costing studies at community clinic settings and to use these to make concrete recommendations on the pricing of HIV services for key populations (MSM, TG, SW and PWID), specifically those related to

1. Reach-to-Recruit
2. HIV Test with consideration in leveraging HIV self-screening testing
3. Possible incentives or optimizing options to increase HIV case finding
4. Risk assessment to differentiated and offer appropriate prevention choices and retention negative of high-risk HIV- individuals including initiative PrEP and
5. Supporting services for same day ART initiation and the retention of HIV+ individuals be maintained on anti-retroviral treatment without interruption over time.

Purpose: EpiC Thailand managed by FHI 360 intends to support this scope of work to assist the Thai Government in making informed decisions and policy changes regarding domestic financing for HIV programs.

Tasks and Deliverables:

The services required of the contractor would include, but not be limited to:

1. Review existing cost studies related to HIV cascade services provided by community-based organizations in Thailand
2. Develop appropriate methods and apply them to estimate any increases in these costs based on inflation or other factors. (FHI 360 will provide most of these studies)
3. Review examples from other countries in the Asia region on the pricing of HIV services by governments and their reimbursement and/or social contracting to community-based organizations to inform recommendations to NHSO. (FHI 360 will provide some of this information)
4. Based on NHSO’s current regulations and system of reimbursements to CBOs, make specific recommendations on the revised pricing or payment of HIV services, specifically those related to
   1. Reach-to-Recruit
   2. HIV Test with consideration in leveraging HIV self-screening testing
   3. Incentives or optimizing options to increase HIV case finding
   4. Retain Negative
      1. Risk assessment to differentiated and offer appropriate prevention choices and
      2. Retention negative for
         1. Substantial risk and/or initiative PrEP
         2. Event based exposed to risk behavior who require PEP
         3. Higher-risk behavior
         4. Low-risk behavior
   5. ART initiation and Retain Positive
      1. Supporting services for same day ART initiation
      2. Retention of HIV+ individuals to be maintained on anti-retroviral treatment without interruption over time.
5. Facilitate the presentation and discussion of these recommendations to stakeholders, including CBOs, MOPH, UNAIDS, donors, selected experts and finally to NHSO.
6. Work with FHI 360 and stakeholders to summarize this review and advocacy process in at least one peer-review article on the pricing of HIV services for reimbursement by the government.
7. Final report in English and Thai